I’m a mid 40s non smoker with family history of lung cancer: Mom (smoker), Dad (smoker) , Maternal Grandmother (nonsmoker, lived with smoker), Maternal Great Aunt (non smoker, lived with smoker). After my parents passed away, one year apart, I asked my family doctor to order a chest CT scan for peace of mind with this family history. My thought is…3 of these 4 family members had no pulmonary symptoms when they were diagnosed with stage 4. Clearly, lung cancer is much more treatable and survivable when caught early. I’m afraid to wait to see if I ever have symptoms because in my family and for many, that’s too late.

So…The dr agreed to scan and after a few years of incidental lung findings (a node, particulate) and yearly CT follow up scans, my lungs are now clear. So according to the pulmonary doc there is no need for follow up. However, I would like to get my lungs checked periodically over time in the hopes of early detection and therefore survival rate, if (and I know it’s a much smaller chance and different scenario since I’m a non smoker) if I were to develop lung cancer. I believe that my family doctor will cooperate and order the tests, but he has no idea about how often I should check. The pulmonary doctor just won’t give me a timeframe and say it’s personal choice…it’s not the standard of care and is “irresponsible” for him to order regular radiation with no symptoms. I understand that position. But I would like to make that personal choice to check things out periodically.

What would you do? Every 2 years? 5? I don’t think there is really science to look at for timing. I know I can’t receive medical advice here so just looking for “what would you do” from people who may know how Lung Cancer develops when it is early. I only know that for my family, waiting until symptoms showed was way too late. Thank you.

Welcome to GRACE. I am sorry that lung cancer has had such a terrible impact on your family, and I understand why you are so concerned. As you probably already know, low-dose CT screening for lung cancer is recommended only for high-risk patients, those with significant smoking history. Dr. West discusses the reasons for limiting these screenings in this post. And Dr. Silvestri describes the screening program here. Under the screening program, low-dose CTs are given yearly.

Unfortunately, since you are not in the high-risk group, there is no guidance on a screening interval. In addition, although all lung cancers take years to develop, there is great variability in the interval between a cancer first being detectable on a scan and becoming widespread, as lung cancers progress at varying rates. By extrapolation, you might assume that the one-year interval chosen for the high-risk group would be appropriate, but any lung cancer you might develop based on familial history would be based on some factor other than smoking history. As a general rule, lung cancers caused by smoking tend to be more aggressive than those that are not, and would be likely to progress more rapidly from early stage to advanced stage. As such, the window to detect an early lung cancer could be wider for a non-smoker’s cancer.

I wish we could provide a more specific answer, but there just isn’t evidence to support one.